Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC).

Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVID _pos ) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVID _neg ) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVID _neg patients at the time of diagnostic testing, COVID _pos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVID _pos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVID _pos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.
Competing Interests: CP, TW, AP, KM, LL, AV This author is an employee of nference with financial interests in the company, RP, DH, JO, AW, GG, JH, AB One or more of the investigators associated with this project and Mayo Clinic have a Financial Conflict of Interest in technology used in the research and that the investigator(s) and Mayo Clinic may stand to gain financially from the successful outcome of the research. Mayo Clinic is an investor in nference. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with Mayo Clinic Conflict of Interest policies. WM One or more of the investigators associated with this project and Mayo Clinic have a Financial Conflict of Interest in technology used in the research and that the investigator(s) and Mayo Clinic may stand to gain financially from the successful outcome of the research. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with Mayo Clinic Conflict of Interest policies. The author is also involved in the Mayo Clinic Laboratories. EB, HM, NK This author is an employee of the Janssen pharmaceutical companies of J&J with financial interests in the company, VS The author is an employee of nference and has financial interests in the company. Outside the submitted work, Venky Soundararajan is listed as inventor of the following patent: "Systems, methods, and computer readable media for visualization of semantic information and inference of temporal signals indicating salient associations between life science entities" (US20180082197A1).
(© 2020, Pawlowski et al.)